The Rationality of Antibiotics Use on Inpatient Department of Pediatric in One of the Hospital in Cimahi

According to the World Health Organization, the use of drugs is rational if the patient gets medication as needed, in a sufficient period, and at the lowest price (OforiAsenso & Agyeman, 2016). The use of the drug is irrational if the possibility of negative impacts received by patients is more significant than its benefits, such as clinical impact, for example, side effects and bacterial resistance, and economic impacts, such as costs are not affordable (Llor & Bjerrum, 2014). Antibiotic resistance remains a significant public health concern, and appropriate antibiotic use is an important health care quality goals (Hersh et al., 2013). Antibiotic resistance initially occurred at the hospital level, but slowly also developed in the community environment (Davies & Davies, 2010). Antibiotic resistance is also occurring in children in different countries, especially in developing countries (Zaman et al., 2017). Prescribing of antibiotics for children only when benefits are proven scientifically. In practice, antibiotics do not need to be prescribed to children for high fever, inflammation of the throat, and diarrhea caused by viral infections (Levy-Hara et al., 2011). The selection of antibiotics depends not only on the spectrum but also the pharmacological properties, the potential for resistance, the safety profile, and the price (Jog, 2016). Appropriate antibiotic use is possible if health workers and the public have access to reliable and unbiased drug information. Universal access to reliable information about medicines can be achieved and must be the basis of efforts to promote rational prescriptions (Maiti et al., 2015). The Rationality of Antibiotics Use on Inpatient Department of Pediatric in One of the Hospital in Cimahi


INTRODUCTION
According to the World Health Organization, the use of drugs is rational if the patient gets medication as needed, in a sufficient period, and at the lowest price (Ofori-Asenso & Agyeman, 2016). The use of the drug is irrational if the possibility of negative impacts received by patients is more significant than its benefits, such as clinical impact, for example, side effects and bacterial resistance, and economic impacts, such as costs are not affordable (Llor & Bjerrum, 2014).
Antibiotic resistance remains a significant public health concern, and appropriate antibiotic use is an important health care quality goals (Hersh et al., 2013). Antibiotic resistance initially occurred at the hospital level, but slowly also developed in the community environment (Davies & Davies, 2010). Antibiotic resistance is also occurring in children in different countries, especially in developing countries (Zaman et al., 2017).
Prescribing of antibiotics for children only when benefits are proven scientifically. In practice, antibiotics do not need to be prescribed to children for high fever, inflammation of the throat, and diarrhea caused by viral infections (Levy-Hara et al., 2011). The selection of antibiotics depends not only on the spectrum but also the pharmacological properties, the potential for resistance, the safety profile, and the price (Jog, 2016). Appropriate antibiotic use is possible if health workers and the public have access to reliable and unbiased drug information.
Universal access to reliable information about medicines can be achieved and must be the basis of efforts to promote rational prescriptions (Maiti et al., 2015).

The Rationality of Antibiotics Use on Inpatient Department of Pediatric in One of the Hospital in Cimahi
To ensure that patients get a rational treatment, especially the use of antibiotics in children, it is necessary to analyze the rationality of antibiotics usage in one of the hospitals in Cimahi, West Java. The purpose of this study is to assess the rationality of the use of antibiotics from inpatients in one hospital in Cimahi.

MATERIALS AND METHODS
The study was conducted using descriptive analysis design, which was carried out retrospectively. Reference used in the analysis of rational antibiotics use is Basic and Clinical Pharmacology 12 th edition (Katzung et al., 2011).

Patient characteristics and medication
Based on the results of the study, there were 165 patients included in the inclusion criteria. Patient characteristics are presented in Table I.    (Kohanski et al., 2010). A study showed that antibiotics that were widely prescribed for children aged < 12 years were penicillins, cephalosporins, and macrolides (Vaz et al., 2014). In the hospital, cefotaxime is used in bronchopneumonia patients, whereas ceftriaxone is given for patients with a diagnose of typhoid fever. Bronchopneumonia and typhoid fever are the two most diagnoses obtained, as seen in Figure 2. Bronchopneumonia is the clinical manifestation of pneumonia that is most common in children. Bronchopneumonia is an infectious disease that causes death in children under five years (Zec et al., 2016).

TF BP TF+BP
Cefotaxime is a third-generation cephalosporin that has broad-spectrum activity and is widely used in the treatment of pneumonia (Yayan et al., 2015). The results of other studies show that the most widely used therapy for pneumonia is antibiotics of penicillin and first and third-generation cephalosporins (Zec et al., 2016).
Ceftriaxone is a third-generation cephalosporin that has high effectiveness against Salmonella typhi and becomes the therapeutic standard of typhoid fever in various countries of the world, but this drug requires parenteral administration, therefore, it is considered less than ideal (Frenck et al., 2000).
The results of the study showed that several patients received combination antibiotic therapy. In general, the use of antibiotic combination aims to increase the effectiveness of antibiotics in eradicating bacteria. Also, the results of the study showed that there was an antibiotics replacement, which was generally due to the previous antibiotics that did not achieve the expected effect. This can be seen from the improvement of the patient's symptoms as well as from the results of examinations such as vital signs, laboratory tests, and others. Replacement antibiotics come from the same group of antibiotics or different groups of antibiotics.     (Slama et al., 2005). The analysis showed that all antibiotics used inpatient BP, TF, and BP+TF are 100% correct, which means that antibiotics were used in cases of infection with diagnosis result that has been established, and 100% correct drug of choice where the drug selected in accordance with the spectrum and is a drug that complies with therapeutic guidelines and has an affordable price. Analysis of drug dosage showed as many as 11.22% subdosage and as many as 23.47% excessive dosages (Katzung et al., 2011;Hilal-Dandan & Brunton, 2008). It may indicate the lack of rationality in giving antibiotics. However, this can also be caused by the patient having less or more bodyweight, thus affecting the administered dose, because generally the dose in child patients is calculated based on body weight.
The dose given can also be influenced by the severity of the infection suffered. Fewer dosages or subdosage can cause bacterial eradiation not to be achieved and potentially lead to resistance, while excessive dosage can increase the risk of adverse effects in patients. Research from Kaparang et al. (2014) showed that as many as 8.93% of the use of antibiotics in children, the dosage is improper.  as well as its levels in the blood, should be maintained to achieve the desired therapeutic effect (Levison & Levison, 2009).

ACKNOWLEDGMENT
We are grateful to the Institute for Research and Community Service of Universitas Jenderal Achmad Yaniwhich has facilitated so that this research can be carried out well.